Introduction

The impact of electrification on public health outcomes does not get sufficient attention, especially in low- and middle-income countries (LMICs), where communities bear a high healthcare burden partly because of limited energy provision.

In 2019, over 770 million people were living without electricity, 75% of whom, an estimated 557 million people, were residing in sub-Saharan Africa. This figure decreased in 2020 and 2021, but in 2022 data from the International Energy Agency showed that the number has increased to 570 million people living without electricity in sub-Saharan Africa. The reversal of the downward trend puts us off course in achieving Sustainable Development Goal 7: access to affordable and sustainable energy for all by 2030.

In this post, I summarize the methods and findings of “Building powerful health systems: the impacts of electrification on health outcomes in LMICs,” a systematic review by Alhadi Khogali, Almegdad Ahmed, Mona Ibrahim, Karrar Karrar, Mohamed Elsheikh, Elfatih Abdelraheem, Lucie Cluver, and Elsiddig Elmukashfi. The systematic review evaluates the impact of electrification on healthcare service, delivery, and outcomes in LMICs, and discusses the implications for Sustainable Development Goals 3 and 7: Ensuring healthy lives and promote well-being for all at all ages; and ensuring access to affordable, reliable, sustainable and modern energy for all.

Methodology

The authors systematically reviewed studies from various data sources and grey literature. They screened 5,083 articles and selected 12 studies that assessed the impact of electrification on healthcare service, delivery, and outcomes. The researchers discarded studies from high-income countries or ones that had incomplete data. The review was specifically focused on data from LMICs as defined by the World Bank. Only five studies were impact evaluations, including one randomized controlled trial and four quasi-experimental studies. Nine studies were from African countries, two from India and one from Fiji.

The authors used the Harmonized Health Facility Assessment (HHFA) survey, which includes four modules to assess the impact of electrification on healthcare facilities. The modules in the survey focus on service readiness, service availability, quality and safety of care, and management and finance. The the authors organized the findings from the studies evaluating the impact of electrification on health systems using the HHFA modules.

Findings

Service readiness

Based on the systematic review, electrification supports service readiness in healthcare facilities. Clinical outcomes improved in Fiji and India due to better oxygen delivering systems, antenatal care improved in six African countries, and hygiene practices improved due to better availability of water pumps. This demonstrates the link between electrification, better health outcomes, and improved sterilization techniques. Lastly, Khogali et. al. highlighted the significance of electrification in maintaining vaccine potency through maintenance of deep freezers, cold boxes and vaccine carriers.

Service availability

According to the authors, electrification can lead to better maternal and child outcomes. In India, vaccination rates and first trimester checkups increased following the establishment of a stable energy supply. The authors also cited an increased number of deliveries. Moreover, in Sierra Leonne, pediatric mortality seemed to improve, while in Uganda maternal deaths were reduced. These findings underscore the role of electrification in improving health care service availability and public health outcomes.

Quality of care

Only three studies discussed the quality of healthcare service provision. Khogali et. al. mentioned that community satisfaction with healthcare facilities markedly increased after electrification suggesting benefits go far beyond just improved health outcomes. Patients reported service availability at night and improved perception regarding cleanliness and security. Despite the marked increase in community satisfaction, service uptake did not change.

Management and finance

The systematic review included four studies that linked electrification with this particular module. Healthcare workers in Uganda, Tanzania and Ghana showed increased motivation due to apparent better working conditions post electrification. In rural India, access to health information improved as people were more likely to use electronics such as televisions after a stable electricity supply was established.

Electrification and sustainable development

Sustainable Development Goal 3: Ensuring healthy lives and promote well-being for all at all ages

Overall, according to Khogali et. al., electrification is a key component in achieving SDG 3. It can make healthcare facilities better equipped to handle emergencies with improved oxygen supplies, sterile tools, overnight staff retention and security. Improved hygiene practices better equip personnel to respond to infectious diseases and prevent outbreaks. Given the COVID-19 pandemic, reinforcing global health security should be at the forefront of every health agenda. Strengthening vaccine services in combination with infection prevention techniques can be the key to preventing future epidemics. My key takeaway is the need to dive into the root causes of emerging global issues and tackle those – based on this systematic review, there should be a greater focus on provision of electrification to improve healthcare service availability, readiness and quality.

Furthermore, this review highlights how electrification can improve quality of care at primary healthcare facilities. For example, in India there was an improvement in provision of essential services in operating rooms following electrification of primary healthcare facilities. This highlights how access to reliable energy can also lead to universal health coverage and bring us closer to achieving SDG 3 by 2030.

Sustainable Development Goal 7: Universal access to affordable, reliable and sustainable and modern energy for all

A lack of reliable and clean energy is an underappreciated social determinant of health. This systematic review provides evidence for the benefit of electrification in the context of achieving SDG 7. The researchers point to the formation of self-sufficient mini power grids to cater to uneven population distributions in LMICs and how they lead to rural electrification as these grids can power surrounding residential and public areas. Moreover, Khogali et. al. highlights the importance of solar power as an important source of energy for LMICs as solar-powered oxygen concentrators are cheaper and more low maintenance as compared to traditional cylinders. However, this systematic review does point out the need to carefully consider renewable energy sources, especially solar power in regions where there are constraints on infrastructure. The perceived benefits have to outweigh the cost of installation and maintenance of such energy sources. Thus, the efficiency of renewable energy sources must be evaluated carefully especially in low-resource and humanitarian settings.

What to consider

There is an urgent need to focus on electrification in rural areas in order to improve global health security, maternal and child outcomes and primary healthcare services. However, this review showed there is limited literature on the impact of electrification on healthcare services and outcomes. More research is needed, especially on the long-term feasibility of renewable energy sources in healthcare systems in LMICs. Additionally, most of the studies included in this systematic review were from African countries – generalization to other geographic regions should be approached with caution. Further analysis to pinpoint common themes and associated significance would have been beneficial.

In conclusion, we need to focus more on providing people basic access to electricity as millions live without it and a good proportion are energy insecure, even in high-income countries. I believe providing conclusive evidence that can shift the focus of the development sector to provision of electricity and change of policy is essential to transforming the public health landscape and strengthening global health systems.

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